Individual
DR. ADAM MATTHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1555 E CLARK ST, POCATELLO, ID 83201-4133
(224) 688-0624
Mailing address
1555 E CLARK ST, POCATELLO, ID 83201-4133
(208) 233-4355
(208) 233-7198
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
P216
ID
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P216
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000391
—
ID
Enumeration date
05/05/2011
Last updated
03/18/2021
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